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• 1. [Article] Three-Year Change in the Wellbeing of Orphaned and Separated Children in Institutional and Family-Based Care Settings in Five Low- and Middle-Income Countries

  Background: With more than 2 million children living in group homes, or "institutions", worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central ...

  Citation × Citation Citation Abstract Copy Title: Three-Year Change in the Wellbeing of Orphaned and Separated Children in Institutional and Family-Based Care Settings in Five Low- and Middle-Income Countries Author: Whetten, Kathryn, Ostermann, Jan, Pence, Brian W., Whetten, Rachel A., Messer, Lynne C., Ariely, Sumedha, O'Donnell, Karen, Wasonga, Augustine l., Vann, Vanroth, Itemba, Dafrosa, Eticha, Misganaw, Madan, Ira, Thielman, Nathan M., Positive Outcomes for Orphans (POFO) Research Team Year: 2014 Background: With more than 2 million children living in group homes, or "institutions", worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers. Methods: A two-stage random sampling methodology identified community representative samples of 1,357 institutional dwelling orphaned and separated children (OSC) and 1,480 family-dwelling OSC aged 6–12 from 5 low and middle income countries. Data were collected from children and their primary caregivers. Survey-analytic techniques and linear mixed effects models describe child wellbeing collected at baseline and at 36 months, including physical and emotional health, growth, cognitive development and memory, and the variation in outcomes between children, care settings, and study sites. Findings: At 36-month follow-up, institution-dwelling OSC had statistically significantly higher height-for-age Z-scores and better caregiver-reported physical health; family-dwelling OSC had fewer caregiver-reported emotional difficulties. There were no statistically significant differences between the two groups on other measures. At both baseline and follow-up, the magnitude of the differences between the institution- and family-dwelling groups was small. Relatively little variation in outcomes was attributable to differences between sites (11–27% of total variation) or care settings within sites (8–14%), with most variation attributable to differences between children within settings (60–75%). The percent of variation in outcomes attributable to the care setting type, institution- versus family-based care, ranged from 0–4% at baseline, 0–3% at 36-month follow-up, and 0–4% for changes between baseline and 36 months. Interpretation: These findings contradict the hypothesis that group home placement universally adversely affects child wellbeing. Without substantial improvements in and support for family settings, the removal of institutions, broadly defined, would not significantly improve child wellbeing and could worsen outcomes of children who are moved from a setting where they are doing relatively well to a more deprived setting. Title: Three-Year Change in the Wellbeing of Orphaned and Separated Children in Institutional and Family-Based Care Settings in Five Low- and Middle-Income Countries Author: Whetten, Kathryn, Ostermann, Jan, Pence, Brian W., Whetten, Rachel A., Messer, Lynne C., Ariely, Sumedha, O'Donnell, Karen, Wasonga, Augustine l., Vann, Vanroth, Itemba, Dafrosa, Eticha, Misganaw, Madan, Ira, Thielman, Nathan M., Positive Outcomes for Orphans (POFO) Research Team Year: 2014 Background: With more than 2 million children living in group homes, or "institutions", worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers. Methods: A two-stage random sampling methodology identified community representative samples of 1,357 institutional dwelling orphaned and separated children (OSC) and 1,480 family-dwelling OSC aged 6–12 from 5 low and middle income countries. Data were collected from children and their primary caregivers. Survey-analytic techniques and linear mixed effects models describe child wellbeing collected at baseline and at 36 months, including physical and emotional health, growth, cognitive development and memory, and the variation in outcomes between children, care settings, and study sites. Findings: At 36-month follow-up, institution-dwelling OSC had statistically significantly higher height-for-age Z-scores and better caregiver-reported physical health; family-dwelling OSC had fewer caregiver-reported emotional difficulties. There were no statistically significant differences between the two groups on other measures. At both baseline and follow-up, the magnitude of the differences between the institution- and family-dwelling groups was small. Relatively little variation in outcomes was attributable to differences between sites (11–27% of total variation) or care settings within sites (8–14%), with most variation attributable to differences between children within settings (60–75%). The percent of variation in outcomes attributable to the care setting type, institution- versus family-based care, ranged from 0–4% at baseline, 0–3% at 36-month follow-up, and 0–4% for changes between baseline and 36 months. Interpretation: These findings contradict the hypothesis that group home placement universally adversely affects child wellbeing. Without substantial improvements in and support for family settings, the removal of institutions, broadly defined, would not significantly improve child wellbeing and could worsen outcomes of children who are moved from a setting where they are doing relatively well to a more deprived setting. Close

• 2. [Article] Mujeres Fuertes y Corazones Saludables: Adaptation of the StrongWomen—Healthy Hearts (SWHH) Program for Rural Latinas Using an Intervention Mapping Approach

  Objectives: To adapt Strong Women, Healthy Hearts (SWHH), an evidence-based physical activity and nutrition program to reflect the needs of rural Latinas. Methods: Using a community-based participatory ...

  Citation × Citation Citation Abstract Copy Title: Mujeres Fuertes y Corazones Saludables: Adaptation of the StrongWomen—Healthy Hearts (SWHH) Program for Rural Latinas Using an Intervention Mapping Approach Author: Jackson, Christie L, Perry, Cynthia K., McCalmont, Jean, Solanki, Emma, Seguin, Rebecca, Ward, Judy P., Menelas, Hannah-Dulya K. Year: 2017 Objectives: To adapt Strong Women, Healthy Hearts (SWHH), an evidence-based physical activity and nutrition program to reflect the needs of rural Latinas. Methods: Using a community-based participatory approach and an intervention mapping process, we partnered with a community advisory board of rural Latinas to identify and adapt a nutrition and physical activity program. A needs assessment and a logic model determined which program best aligned with community objectives and most fit for adaptation. SWHH was adapted; using feedback from the community advisory board to reflect the community’s culture, resources, and needs. We collaborated with one of developers of SWHH in the adaptation process to ensure evidence-based elements were retained. Intervention strategies, program curriculum, materials, and structure were adapted. An example adaptation was changing recipes to include similar nutritional content that align with the culture and local resources. Another example was training community members to lead the class instead of extension agents which were leaders in SWHH. Results/Findings: Through this adaptation process the adapted program, Mujeres Fuertes, Corazones Saludables was formed. We have translated all participant materials into Spanish and have revised the curriculum to reflect changes made. A pilot study is being conducted with overweight, sedentary, middle-aged, Spanish-speaking, rural Latinas to assess feasibility and effectiveness of adapted program. We are measuring weight, cardiorespiratory fitness, physical activity and nutrition behavior before and after the 12-week program. The data has been collected at the two time points and evaluation is underway. Conclusions: The intervention mapping process was appropriate and collaboration with the community advisory board ensured culturally appropriate and relevant adaptations to the local community context. Title: Mujeres Fuertes y Corazones Saludables: Adaptation of the StrongWomen—Healthy Hearts (SWHH) Program for Rural Latinas Using an Intervention Mapping Approach Author: Jackson, Christie L, Perry, Cynthia K., McCalmont, Jean, Solanki, Emma, Seguin, Rebecca, Ward, Judy P., Menelas, Hannah-Dulya K. Year: 2017 Objectives: To adapt Strong Women, Healthy Hearts (SWHH), an evidence-based physical activity and nutrition program to reflect the needs of rural Latinas. Methods: Using a community-based participatory approach and an intervention mapping process, we partnered with a community advisory board of rural Latinas to identify and adapt a nutrition and physical activity program. A needs assessment and a logic model determined which program best aligned with community objectives and most fit for adaptation. SWHH was adapted; using feedback from the community advisory board to reflect the community’s culture, resources, and needs. We collaborated with one of developers of SWHH in the adaptation process to ensure evidence-based elements were retained. Intervention strategies, program curriculum, materials, and structure were adapted. An example adaptation was changing recipes to include similar nutritional content that align with the culture and local resources. Another example was training community members to lead the class instead of extension agents which were leaders in SWHH. Results/Findings: Through this adaptation process the adapted program, Mujeres Fuertes, Corazones Saludables was formed. We have translated all participant materials into Spanish and have revised the curriculum to reflect changes made. A pilot study is being conducted with overweight, sedentary, middle-aged, Spanish-speaking, rural Latinas to assess feasibility and effectiveness of adapted program. We are measuring weight, cardiorespiratory fitness, physical activity and nutrition behavior before and after the 12-week program. The data has been collected at the two time points and evaluation is underway. Conclusions: The intervention mapping process was appropriate and collaboration with the community advisory board ensured culturally appropriate and relevant adaptations to the local community context. Close

• 3. [Article] A Program Evaluation of a Housing With Services Project for Low-Income Adults in Portland, Oregon

  Reducing hospital use and connecting individuals to local available services and supports are key features of the Affordable Care Act. Adult residents of public housing tend to experience worse health ...

  Citation × Citation Citation Abstract Copy Title: A Program Evaluation of a Housing With Services Project for Low-Income Adults in Portland, Oregon Author: Phillips, Jack A, Carder, Paula C., White, Diana Year: 2014 Reducing hospital use and connecting individuals to local available services and supports are key features of the Affordable Care Act. Adult residents of public housing tend to experience worse health outcomes than other adults. Poor self-rated health and high rates of emergency department use and hospitalization among these residents have prompted efforts to improve health outcomes. Even among residents living independently, prior research indicates that health and social disparities can be effectively addressed through coordinated care and improved access to health and social services. Cedar Sinai Park—a nonprofit residential care organization located in Portland, Oregon—will implement a demonstration project attempting to connect low-income adults living in affordable and public housing with health and social services. Funded by the Oregon Health Authority, this demonstration is a potential model for other housing with services providers in Oregon and nationally. Services will be provided through a consortium of local agencies and evaluated by Portland State University’s Institute on Aging. The evaluation consists of three components: 1) Process evaluation, 2) Satisfaction surveys, and 3) Resident surveys. In addition, health service utilization data will be analyzed. Data will be collected using a combination of in-person and mailed surveys administered before and after the demonstration project is implemented. Quantitative analyses will examine whether hospital use declines and self-rated health improves, and whether the program is cost effective. This poster will describe the program planning that led to the demonstration and detail the program evaluation components including sampling, data collection strategies, and planned analysis. Title: A Program Evaluation of a Housing With Services Project for Low-Income Adults in Portland, Oregon Author: Phillips, Jack A, Carder, Paula C., White, Diana Year: 2014 Reducing hospital use and connecting individuals to local available services and supports are key features of the Affordable Care Act. Adult residents of public housing tend to experience worse health outcomes than other adults. Poor self-rated health and high rates of emergency department use and hospitalization among these residents have prompted efforts to improve health outcomes. Even among residents living independently, prior research indicates that health and social disparities can be effectively addressed through coordinated care and improved access to health and social services. Cedar Sinai Park—a nonprofit residential care organization located in Portland, Oregon—will implement a demonstration project attempting to connect low-income adults living in affordable and public housing with health and social services. Funded by the Oregon Health Authority, this demonstration is a potential model for other housing with services providers in Oregon and nationally. Services will be provided through a consortium of local agencies and evaluated by Portland State University’s Institute on Aging. The evaluation consists of three components: 1) Process evaluation, 2) Satisfaction surveys, and 3) Resident surveys. In addition, health service utilization data will be analyzed. Data will be collected using a combination of in-person and mailed surveys administered before and after the demonstration project is implemented. Quantitative analyses will examine whether hospital use declines and self-rated health improves, and whether the program is cost effective. This poster will describe the program planning that led to the demonstration and detail the program evaluation components including sampling, data collection strategies, and planned analysis. Close

• 4. [Article] Association of Depressive Symptomology and Psychological Trauma with Diabetes Control Among Older American Indian Women: Does Social Support Matter?

  Aims—Among older American Indian women with type 2 diabetes (T2DM), we examined the association between mental health and T2DM control and if social support modifies the association. Methods—Survey data ...

  Citation × Citation Citation Abstract Copy Title: Association of Depressive Symptomology and Psychological Trauma with Diabetes Control Among Older American Indian Women: Does Social Support Matter? Author: Goins, R. Turner, Noonan, Carolyn, Gonzales, Kelly, Winchester, Blythe, Bradley, Vickie L. Year: 2017 Aims—Among older American Indian women with type 2 diabetes (T2DM), we examined the association between mental health and T2DM control and if social support modifies the association. Methods—Survey data were linked to T2DM medical record information. Mental health measures were the Center for Epidemiologic Studies – Depression Scale and the National Anxiety Disorders Screening Day instrument. T2DM control was all HbA1c values taken post mental health measures. Results—There was not a significant association between depressive symptomatology and higher HbA1c although increased depressive symptomatology was associated with higher HbA1c values among participants with low social support. There was a significant association between psychological trauma and higher HbA1c values 12 months [mean 7.5, 95% CI 7.0–8.0 for no trauma vs. mean 7.0, 95% CI 6.3–7.6 for trauma with no symptoms vs. mean 8.4, 95% CI 7.7–9.1 for trauma with =1 symptom(s)] and 6 months later [mean 7.2, 95% CI 6.7–7.7 for no trauma vs. mean HbA1c 6.8, 95% CI 6.2–7.4 for trauma with no symptoms vs. mean 8.4, 95% CI 7.6–9.2 for trauma with ≥1 symptom(s)]. High social support attenuated the association between psychological trauma and HbA1c values. Conclusions—T2DM programs may consider activities that would strengthen participants’ social support and thereby building on an intrinsic community strength. Title: Association of Depressive Symptomology and Psychological Trauma with Diabetes Control Among Older American Indian Women: Does Social Support Matter? Author: Goins, R. Turner, Noonan, Carolyn, Gonzales, Kelly, Winchester, Blythe, Bradley, Vickie L. Year: 2017 Aims—Among older American Indian women with type 2 diabetes (T2DM), we examined the association between mental health and T2DM control and if social support modifies the association. Methods—Survey data were linked to T2DM medical record information. Mental health measures were the Center for Epidemiologic Studies – Depression Scale and the National Anxiety Disorders Screening Day instrument. T2DM control was all HbA1c values taken post mental health measures. Results—There was not a significant association between depressive symptomatology and higher HbA1c although increased depressive symptomatology was associated with higher HbA1c values among participants with low social support. There was a significant association between psychological trauma and higher HbA1c values 12 months [mean 7.5, 95% CI 7.0–8.0 for no trauma vs. mean 7.0, 95% CI 6.3–7.6 for trauma with no symptoms vs. mean 8.4, 95% CI 7.7–9.1 for trauma with =1 symptom(s)] and 6 months later [mean 7.2, 95% CI 6.7–7.7 for no trauma vs. mean HbA1c 6.8, 95% CI 6.2–7.4 for trauma with no symptoms vs. mean 8.4, 95% CI 7.6–9.2 for trauma with ≥1 symptom(s)]. High social support attenuated the association between psychological trauma and HbA1c values. Conclusions—T2DM programs may consider activities that would strengthen participants’ social support and thereby building on an intrinsic community strength. Close